TO SEE OR NOT TO SEE? POST-OPERATIVE FOLLOW-UP IN GENERAL GYNAECOLOGY

Sam Lepine, Simon M Scheck, Henry Gribben, Fali Langdana, Kristin Andre

Abstract


Background: There is no convincing evidence of benefit to routine post-operative follow-up appointments in general gynaecology; evaluation of comparable health care systems suggests this may be omitted without detriment. This may open up avenues for improved efficiency of outpatient clinics with decreased expense to the patient.

Aims: This study sought to describe the burden of post-operative follow-up and provoke discussion on alternative models of care.

Materials and Methods: This retrospective audit was conducted of 767 patients attending their first post-operative outpatient appointment following benign gynaecological surgery in 2017. Demographic and clinical details were recorded as was patient travel, histology, presence of complications or complaints and closing outcome.

Results: Seventy-three per cent of the time there was no clear benefit to the post-operative appointment. All cases of pre malignant or malignant histology were reliably suspected pre-operatively. There was no clinical information that had a significantly increased risk of complication, complaint or need for further input.

Conclusions: This study indicates that conventional post-operative care may add cost to both system and patient without demonstrable benefit in a large proportion of cases. Formulating a virtual clinic for telephone follow-up in benign gynaecology would require co-ordination from multiple stakeholders but may considerably improve the efficiency of our service.

Keywords


Gynecologic surgery, Outpatient clinic, Follow-up care, Gynecologic diseases, Aftercare

Full Text:

PDF

References


Fraser IS, Angsuwathana S, Mahmoud F, et al. Short and medium term outcomes after rollerball endometrial ablation for menorrhagia. Med J Aust 1993;158:454–7.http://www.ncbi.nlm.nih.gov/pubmed/8469193 (accessed 7 Oct 2018).

McPherson K, Metcalfe MA, Herbert A, et al. Severe complications of hysterectomy: the VALUE study. BJOG An Int J Obstet Gynaecol 2004;111:688–94. doi:10.1111/j.1471-0528.2004.00174.x

Clarke T, Galaal K, Bryant A, et al. Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment. Cochrane Database Syst Rev Published Online First: 8 September 2014. doi:10.1002/14651858.CD006119.pub3

Moschetti I, Cinquini M, Lambertini M, et al. Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev Published Online First: 27 May 2016. doi:10.1002/14651858.CD001768.pub3

Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database Syst Rev Published Online First: 18 October 2006. doi:10.1002/14651858.CD004510.pub3

Gombeski WRJ, Miller PJ, Hahn JH, et al. Patient callback program: A quality improvement, customer service, and marketing tool. J Health Care Mark 1993;13:60.https://search.proquest.com/openview/c1adbcfb85b504d0bc88c13870bfb221/1?pq-origsite=gscholar&cbl=36770 (accessed 7 Oct 2018).

Jerant AF, Azari R, Nesbitt TS. Reducing the cost of frequent hospital admissions for congestive heart failure: a randomized trial of a home telecare intervention. Med Care 2001;39:1234–45.http://www.ncbi.nlm.nih.gov/pubmed/11606877 (accessed 7 Oct 2018).

Kimman ML, Dirksen CD, Voogd AC, et al. Economic evaluation of four follow-up strategies after curative treatment for breast cancer: Results of an RCT. Eur J Cancer 2011;47:1175–85. doi:10.1016/j.ejca.2010.12.017

Fischer K, Hogan V, Jager A, et al. Efficacy and utility of phone call follow-up after pediatric general surgery versus traditional clinic follow-up. Perm J 2015;19:11–4. doi:10.7812/TPP/14-017

Capital and Coast District Health Board. The Women’s Health Service Annual Clinical Report 2016. 2016. Wellington, New Zealand. Accessed at: https://www.ccdhb.org.nz/news-publications/publications-and-consultation-documents/ccdhb-whs-2016-annual-clinical-report.pdf October 2018

National Health and Medical Research Council. Ethical Considerations in Quality Assurance and Evaluation Activities. 2014. Accessed at https://nhmrc.gov.au/about-us/publications/ethical-considerations-quality-assurance-and-evaluation-activities October 2018

Munro MG, Critchley HOD, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet 2011;113:3–13. doi:10.1016/j.ijgo.2010.11.011

Ladfors MB, Löfgren MEO, Gabriel B, et al. Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 2002;81:437–437. doi:10.1080/j.1600-0412.2001.810511.x

Johnson A, Sandford J, Tyndall J. Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Database Syst Rev Published Online First: 20 October 2003. doi:10.1002/14651858.CD003716


Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2018 INTERNATIONAL EDUCATION AND RESEARCH JOURNAL